| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,583 |
4,494 |
$96K |
| D1120 |
Prophylaxis - child |
2,942 |
2,884 |
$88K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
716 |
481 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,656 |
4,567 |
$70K |
| D1110 |
Prophylaxis - adult |
1,525 |
1,494 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,244 |
2,211 |
$40K |
| D0330 |
Panoramic radiographic image |
518 |
510 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
807 |
788 |
$21K |
| D2140 |
|
183 |
139 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
333 |
330 |
$5K |
| D0602 |
|
485 |
401 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
118 |
118 |
$3K |